Request For Formal Leave Of Absence Form - California State University Fullerton (Page 2 of 18) in pdf

EPARTMENT OF

AIR

MPLOYMENT AND

OUSING

STATE OF CALIFORNIA

"NOTICE B"

FAMILY CARE AND MEDICAL LEAVE AND PREGNANCY DISABILITY LEAVE

• Under the California Family Rights Act of 1993 (CFRA), if you have more than 12 months of service with your employer

and have worked at least 1,250 hours in the 12-month period before the date you want to begin your leave, you may have

a right to an unpaid family care or medical leave (CFRA leave). This leave may be up to 12 workweeks in a 12-month

period for the birth, adoption, or foster care placement of your child or for your own serious health condition or that of your

child, parent or spouse.

• Even if you are not eligible for CFRA leave, if disabled by pregnancy, childbirth or related

medical conditions, you are entitled to take pregnancy disability leave (PDL) of up to four

months, or the working days in one-third of a year or 17⅓ weeks, depending on your period(s) of actual disability. Time off

needed for prenatal or postnatal care; doctor-ordered bed rest; gestational diabetes; pregnancy-induced hypertension;

preeclampsia; childbirth; postpartum depression; loss or end of pregnancy; or recovery from childbirth or loss or end of

pregnancy would all be covered by your PDL.

• Your employer also has an obligation to reasonably accommodate your medical needs (such as allowing more frequent

breaks) and to transfer you to a less strenuous or hazardous position if it is medically advisable because of your

pregnancy.

• If you are CFRA-eligible, you have certain rights to take BOTH PDL and a separate CFRA leave for reason of the birth of

your child. Both leaves guarantee reinstatement to the same or a comparable position at the end of the leave, subject to

any defense allowed under the law. If possible, you must provide at least 30 days advance notice for foreseeable events

(such as the expected birth of a child or a planned medical treatment for yourself or a family member). For events that are

unforeseeable, you must to notify your employer, at least verbally, as soon as you learn of the need for the leave.

• Failure to comply with these notice rules is grounds for, and may result in, deferral of the requested leave until you

comply with this notice policy.

• Your employer may require medical certification from your health care provider before allowing you a leave for:

o your pregnancy;

o your own serious health condition; or

o to care for your child, parent, or spouse who has a serious health condition.

• See your employer for a copy of a medical certification form to give to your health care provider to complete.

• When medically necessary, leave may be taken on an intermittent or a reduced work schedule. If you are taking a leave

for the birth, adoption or foster care placement of a child, the basic minimum duration of the leave is two weeks and you

must conclude the leave within one year of the birth or placement for adoption or foster care.

• Taking a family care or pregnancy disability leave may impact certain of your benefits and your seniority date. Contact

your employer for more information regarding your eligibility for a leave and/or the impact of the leave on your seniority and

benefits.

This notice is a summary of your rights and obligations under the Fair Employment and Housing Act (FEHA). The FEHA

prohibits employers from denying, interfering with, or restraining your exercise of these rights. For more information about

your rights and obligations, contact your employer, visit the Department of Fair Employment and Housing's Web site at

, or contact the Department at (800) 884-1684. The text of the FEHA and the regulations interpreting it are

available on the Department's Web site.

I have read and understand my rights explained in the above notice

Request For Formal Leave Of Absence Form - California State University Fullerton Page 2

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